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  1 / 15175 MEDLINE  
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[PMID]:29386005
[Au] Autor:Stub T; Quandt SA; Arcury TA; Sandberg JC; Kristoffersen AE
[Ad] Endereço:Wake Forest School of Medicine, Department of Epidemiology and Prevention, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC, 27157, USA. trine.stub@uit.no.
[Ti] Título:Attitudes and knowledge about direct and indirect risks among conventional and complementary health care providers in cancer care.
[So] Source:BMC Complement Altern Med;18(1):44, 2018 Jan 31.
[Is] ISSN:1472-6882
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many complementary therapies offer benefits for patients with cancer. Others may be risky for patients due to negative interactions with conventional treatment and adverse effects. Therefore, cancer patients need guidance from health care providers to assess complementary modalities appropriately to receive benefits and avoid harm. METHOD: In a self-administered questionnaire-based cross-sectional study, we compared knowledge and attitudes of health care providers with no training in complementary modalities to that of health care providers with training in complementary modalities about the risks for patients who combine complementary modalities with conventional treatment in cancer care. The analysis was based on responses from 466 participants. RESULTS: The attitudes and knowledge about direct risk followed provider specialty. Ninety-four percent of the medical doctors, 93% of the nurses, and 87% of the providers with dual training, but 70% of the complementary therapists, believed that complementary modalities can cause adverse effects (p < 0.001). The majority of the medical doctors and nurses believed that it is risky to combine complementary and conventional cancer treatments (78% and 93%, respectively), compared to 58% of the providers with dual training and 43% of the complementary therapists (p < 0.001). Eighty-nine percent of the medical doctors and nurses believed that complementary modalities should be subjected to more scientific testing before being accepted by conventional health care providers, in contrast to 56% of the dually trained and 57% of the complementary therapists (p < 0.001). The majority of the medical doctors (61%) and nurses (55%) would have neither discouraged nor encouraged the use of complementary modalities if patients asked them for advice. Moreover, less than 1% of the complementary therapists would have discouraged the use of conventional cancer treatments. The study participants believed that the most important factor to recommend a complementary cancer modality to patients is evidence for safety. CONCLUSION: The health care providers in this study believed that complementary modalities are associated with direct risk and can cause adverse effects, and that it is risky to combine conventional and complementary treatments due to potential harmful interactions.
[Mh] Termos MeSH primário: Terapias Complementares
Conhecimentos, Atitudes e Prática em Saúde
Pessoal de Saúde/psicologia
Pessoal de Saúde/estatística & dados numéricos
Padrões de Prática Médica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Segurança do Paciente
Medição de Risco
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1186/s12906-018-2106-z


  2 / 15175 MEDLINE  
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[PMID]:28462932
[Au] Autor:Gemperli A; Ronca E; Scheel-Sailer A; Koch HG; Brach M; Trezzini B; SwiSCI Study Group
[Ad] Endereço:Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland.
[Ti] Título:Health care utilization in persons with spinal cord injury: part 1-outpatient services.
[So] Source:Spinal Cord;55(9):823-827, 2017 Sep.
[Is] ISSN:1476-5624
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:STUDY DESIGN: This was a cross-sectional questionnaire survey. OBJECTIVES: The objective of this study was to identify the care-seeking behavior of persons with spinal cord injury (SCI) with respect to the various health care providers and ascertain circumstances that lead to situations where required care was not received. SETTING: This study was conducted in the entire country of Switzerland. METHODS: Statistical analysis of frequency of annual visits to health care providers by 17 specialties, and description of situations where health care was required but not received, in persons with chronic SCI living in the community. RESULTS: Main medical contact person was the general practitioner (GP; visited by 88% during last 12 months). The physiotherapist (visited by 72%) was the health care provider with the most visits (average of 30 visits in 12 months). GPs, physiotherapists, urologists and spinal medicine specialists were often contacted in combination, by many participants, often for check-up visits. A situation where care was required but not received was reported by 53 (11%) of participants, with a substantially higher rate in migrants (29%). Main problems why care was not received were bladder and bowel problems and main reasons of care not received were regional or temporal unavailability. CONCLUSIONS: Individuals with SCI are frequent users of medical services. There is no group of medical specialists that covers all needs of persons with SCI, what emphasizes health care provision from a comprehensive perspective including a wide array of services. Instances with care required but not received appeared to be rare and more likely in participants with migration background.
[Mh] Termos MeSH primário: Assistência Ambulatorial/utilização
Aceitação pelo Paciente de Cuidados de Saúde
Traumatismos da Medula Espinal/terapia
[Mh] Termos MeSH secundário: Doença Crônica
Terapias Complementares/utilização
Estudos Transversais
Feminino
Seres Humanos
Vida Independente
Masculino
Meia-Idade
Autorrelato
Traumatismos da Medula Espinal/epidemiologia
Suíça
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1038/sc.2017.44


  3 / 15175 MEDLINE  
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[PMID]:29356888
[Au] Autor:Firkins R; Eisfeld H; Keinki C; Buentzel J; Hochhaus A; Schmidt T; Huebner J
[Ad] Endereço:Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
[Ti] Título:The use of complementary and alternative medicine by patients in routine care and the risk of interactions.
[So] Source:J Cancer Res Clin Oncol;144(3):551-557, 2018 Mar.
[Is] ISSN:1432-1335
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients suffering from cancer often make use of complementary and alternative medicine (CAM). Only few data exist on the prevalence and clinical significance of interactions of a biological CAM method and conventional drugs. METHODS: From February 2014 to March 2016, consecutive patients from five oncological practices in Germany were asked to fulfill a standardized questionnaire regarding use of CAM. Data on diagnosis, date of first diagnosis, ECOG and the past and current treatment were derived from the patients' files. Interactions were evaluated by systematically using a database on potential interactions. RESULTS: From 1000 patients asked to participate, we received a total of 720 questionnaires of which 711 were completed and eligible for evaluation. 29% of the patients reported any CAM usage. Women showed a significantly higher use of CAM with 35.6 versus 23.6% of men. For 54.9% of CAM users (15.9% of all patients), we found a combination of conventional drugs and biological based CAM methods with a risk for interactions. Vitamins A, C and E were the most frequently used CAM substances in these cases (39.3%), followed by herbs with 17.5%. CONCLUSION: There was a risk of interactions between a biological CAM method and conventional drugs in 54.9% of the patients using CAM. To raise knowledge on interactions a better training for doctors with respect to CAM is strongly needed. Furthermore, patients' awareness should also be raised and communication between physician and patient on the topic improved.
[Mh] Termos MeSH primário: Terapias Complementares/estatística & dados numéricos
Interações Ervas-Drogas
Neoplasias/epidemiologia
Neoplasias/terapia
Atenção Primária à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Alemanha/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Relações Médico-Paciente
Prevalência
Medição de Risco
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[St] Status:MEDLINE
[do] DOI:10.1007/s00432-018-2587-7


  4 / 15175 MEDLINE  
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[PMID]:29206653
[Au] Autor:Kang JM; Lin S
[Ad] Endereço:Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA.
[Ti] Título:Ginkgo biloba and its potential role in glaucoma.
[So] Source:Curr Opin Ophthalmol;29(2):116-120, 2018 Mar.
[Is] ISSN:1531-7021
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE OF REVIEW: This study will review the research on the effect of ginkgo biloba extract (GBE) on patients with glaucoma. RECENT FINDINGS: GBE appears to increase ocular blood flow in those with glaucoma. However, data on visual field outcomes are inconclusive. SUMMARY: GBE has been shown to have antioxidant and vascular effects, making it potentially effective in treating glaucoma. Published data are limited but show an increase in ocular blood flow after GBE administration. Conclusive evidence is lacking regarding the effect of GBE on clinical outcomes in glaucoma patients such as visual field performance.
[Mh] Termos MeSH primário: Terapias Complementares
Glaucoma/tratamento farmacológico
Pressão Intraocular/efeitos dos fármacos
Fitoterapia/métodos
Extratos Vegetais/uso terapêutico
[Mh] Termos MeSH secundário: Animais
Ginkgo biloba/química
Glaucoma/fisiopatologia
Seres Humanos
Pressão Intraocular/fisiologia
Fluxo Sanguíneo Regional/fisiologia
Campos Visuais/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Plant Extracts); 19FUJ2C58T (Ginkgo biloba extract)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1097/ICU.0000000000000459


  5 / 15175 MEDLINE  
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[PMID]:28749702
[Au] Autor:Taylor SL; Giannitrapani KF; Yuan A; Marshall N
[Ad] Endereço:1 Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), Greater Los Angeles VA Healthcare System, Los Angeles, CA.
[Ti] Título:What Patients and Providers Want to Know About Complementary and Integrative Health Therapies.
[So] Source:J Altern Complement Med;24(1):85-89, 2018 Jan.
[Is] ISSN:1557-7708
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: We conducted a quality improvement project to determine (1) what information providers and patients most wanted to learn about complementary and integrative health (CIH) therapies and (2) in what format they wanted to receive this information. The overall aim was to develop educational materials to facilitate the CIH therapy decision-making processes. DESIGN: We used mixed methods to iteratively pilot test and revise provider and patient educational materials on yoga and meditation. We conducted semistructured interviews with 11 medical providers and held seven focus groups and used feedback forms with 52 outpatients. We iteratively developed and tested three versions of both provider and patient materials. Activities were conducted at four Veterans Administration medical facilities (two large medical centers and two outpatient clinics). RESULTS: Patients want educational materials with clearly stated basic information about: (1) what mindfulness and yoga are, (2) what a yoga/meditation class entails and how classes can be modified to suit different abilities, (3) key benefits to health and wellness, and (4) how to find classes at the hospital/clinic. Diverse media (videos, handouts, pocket guides) appealed to different Veterans. Videos should depict patients speaking to patients and demonstrating the CIH therapy. Written materials should be one to three pages with colors, and images and messages targeting a variety of patients. Providers wanted a concise (one-page) sheet in black and white font with no images listing the scientific evidence for CIH therapies from high-impact journals, organized by either type of CIH or health condition to use during patient encounters, and including practical information about how to refer patients. CONCLUSIONS: Providers and patients want to learn more about CIH therapies, but want the information in succinct, targeted formats. The information learned and materials developed in this study can be used by others to educate patients and providers on CIH therapies.
[Mh] Termos MeSH primário: Terapias Complementares
Pessoal de Saúde
Medicina Integrativa
Educação de Pacientes como Assunto
[Mh] Termos MeSH secundário: Seres Humanos
Melhoria de Qualidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1089/acm.2017.0074


  6 / 15175 MEDLINE  
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[PMID]:29357855
[Au] Autor:Zörgo S; Purebl G; Zana Á
[Ad] Endereço:Semmelweis University, Institute of Behavioural Sciences, 4 Nagyvárad tér, Budapest, 1089, Hungary. zorgoszilvia@gmail.com.
[Ti] Título:A qualitative study of culturally embedded factors in complementary and alternative medicine use.
[So] Source:BMC Complement Altern Med;18(1):25, 2018 Jan 22.
[Is] ISSN:1472-6882
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Within the intercultural milieu of medical pluralism, a nexus of worldviews espousing distinct explanatory models of illness, our research aims at exploring factors leading to complementary and alternative medicine (CAM) use with special attention to their cultural context. METHODS: The results are based on medical anthropological fieldwork (participant observation and in-depth interviews) spanning a period from January 2015 to May 2017 at four clinics of Traditional Chinese Medicine in Budapest, Hungary. Participant observation involved 105 patients (males N = 42); in-depth interviews were conducted with patients (N = 9) and practitioners (N = 9). The interviews were coded with Interpretative Phenomenological Analysis; all information was aggregated employing Atlas.ti software. RESULTS: In order to avoid the dichotomization of "push and pull factors," results obtained from the fieldwork and interviews were structured along milestones of the patient journey. These points of reference include orientation among sources of information, biomedical diagnosis, patient expectations and the physician-patient relationship, the biomedical treatment trajectory and reasons for non-adherence, philosophical congruence, and alternate routes of entry into the world of CAM. All discussed points which are a departure from the strictly western therapy, entail an underlying socio-cultural disposition and must be scrutinized in this context. CONCLUSIONS: The influence of one's culturally determined explanatory model is ubiquitous from the onset of the patient journey and exhibits a reciprocal relationship with subjective experience. Firsthand experience (or that of the Other) signifies the most reliable source of information in matters of illness and choice of therapy. Furthermore, the theme of (building and losing) trust is present throughout the patient journey, a determining factor in patient decision-making and dispositions toward both CAM and biomedicine.
[Mh] Termos MeSH primário: Antropologia Médica
Terapias Complementares
Comportamentos Relacionados com a Saúde/etnologia
Medicina Tradicional Chinesa
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE
[do] DOI:10.1186/s12906-018-2093-0


  7 / 15175 MEDLINE  
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[PMID]:29321023
[Au] Autor:Wiesener S; Salamonsen A; Fønnebø V
[Ad] Endereço:The National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway. solveig.wiesener@uit.no.
[Ti] Título:Which risk understandings can be derived from the current disharmonized regulation of complementary and alternative medicine in Europe?
[So] Source:BMC Complement Altern Med;18(1):11, 2018 Jan 10.
[Is] ISSN:1472-6882
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many European citizens are seeking complementary and alternative medicine (CAM). These treatments are regulated very differently in the EU/EFTA countries. This may demonstrate differences in how risk associated with the use of CAM is perceived. Since most CAM treatments are practiced fairly similarly across Europe, differing risk understandings may influence patient safety for European CAM users. The overall aim of this article is thus to contribute to an overview and awareness of possible differing risk understandings in the field of CAM at a policymaking/structural level in Europe. METHODS: The study is a re-analysis of data collected in the CAMbrella EU FP7 document and interview study on the regulation of CAM in 39 European countries. The 12 CAM modalities included in the CAMbrella study were ranked with regard to assumed risk potential depending on the number of countries limiting its practice to regulated professions. The 39 countries were ranked according to how many of the included CAM modalities they limit to be practiced by regulated professions. RESULTS: Twelve of 39 countries generally understand the included CAM treatments to represent "high risk", 20 countries "low risk", while the remaining 7 countries understand CAM treatments as carrying "very little or no risk". The CAM modalities seen as carrying a risk high enough to warrant professional regulation in the highest number of countries are chiropractic, acupuncture, massage, homeopathy and osteopathy. The countries understanding most of the CAM modalities in the study as potentially high-risk treatments are with two exceptions (Portugal and Belgium) all concentrated in the southeastern region of Europe. CONCLUSION: The variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe. We think the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. We argue that it is important for patient safety that policy makers across Europe address this confusing situation. This could be done by applying the WHO patient safety definitions and EU's policy to facilitate access to "safe and high-quality healthcare", and regulate CAM accordingly.
[Mh] Termos MeSH primário: Terapias Complementares
Pessoal de Saúde
Segurança do Paciente
[Mh] Termos MeSH secundário: Terapias Complementares/legislação & jurisprudência
Terapias Complementares/organização & administração
Terapias Complementares/normas
Europa (Continente)
Pessoal de Saúde/legislação & jurisprudência
Pessoal de Saúde/normas
Pessoal de Saúde/estatística & dados numéricos
Seres Humanos
Segurança do Paciente/legislação & jurisprudência
Segurança do Paciente/normas
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.1186/s12906-017-2073-9


  8 / 15175 MEDLINE  
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[PMID]:29363514
[Au] Autor:Roberts S
[Ad] Endereço:Leeds Teaching Hospitals and Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds LS2 9NL, UK.
[Ti] Título:Physician associates: different from but complementary to general practitioners.
[So] Source:BMJ;360:k244, 2018 01 23.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Clínicos Gerais
Médicos de Família
[Mh] Termos MeSH secundário: Terapias Complementares
Seres Humanos
Assistentes Médicos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k244


  9 / 15175 MEDLINE  
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[PMID]:29374723
[Au] Autor:Robella M; Vaira M; Borsano A; Mossetti C; DE Simone M
[Ad] Endereço:Unit of Surgical Oncology, Candiolo Cancer Institute, IRCCS - FPO, Candiolo, Italy manuela.robella@ircc.it.
[Ti] Título:Low-dose Pressurized Intrathoracic Aerosol Chemotherapy (PITAC) as an Alternative Therapy for Pleuropulmonary Involvement in Pseudomyxoma Peritonei.
[So] Source:Anticancer Res;38(2):929-932, 2018 02.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: Pseudomyxoma peritonei (PMP) is a rare disease characterized by mucinous ascites and widespread peritoneal implants. It usually originates from the rupture of an adenoma/adenocarcinoma of the appendix. Although this tumor is only superficially invasive and does not metastasize, it could be a fatal disease. Extra-abdominal spread of PMP is an unusual occurrence with few reports in medical literature. CASE REPORT: A 50-year-old man was diagnosed with PMP according to the findings of thorax and abdomen CT scan and cytologic and histological examinations. The radiological exam showed irregular thickening on the surface of left diaphragmatic and parietal pleura. RESULTS: First, cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy (HIPEC) for the abdominal disease was performed. Histopathological examination confirmed the diagnosis of low grade PMP. The radiological evaluation performed 5 months later showed a dimensional increase in pleural nodules. The treatment consisted of an extensive intrathoracic cytoreductive surgery in combination with pressurized intra-thoracic aerosol chemotherapy (PITAC). Postoperative course was uneventful. CONCLUSION: PMP with pleural extension is a rare phenomenon and carries an unfavourable prognosis. Due to the rarity of this presentation, its correct treatment is still unclear. We present a therapeutic approach to be applied in selected patients.
[Mh] Termos MeSH primário: Terapias Complementares
Procedimentos Cirúrgicos de Citorredução
Hipertermia Induzida
Neoplasias Pulmonares/terapia
Neoplasias Peritoneais/terapia
Neoplasias Pleurais/terapia
Pseudomixoma Peritoneal/terapia
[Mh] Termos MeSH secundário: Terapia Combinada
Seres Humanos
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Neoplasias Peritoneais/patologia
Neoplasias Pleurais/patologia
Prognóstico
Pseudomixoma Peritoneal/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180129
[St] Status:MEDLINE


  10 / 15175 MEDLINE  
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[PMID]:29192424
[Au] Autor:Heras-Mosteiro J; Monge-Maillo B; Pinart M; Lopez Pereira P; Reveiz L; Garcia-Carrasco E; Campuzano Cuadrado P; Royuela A; Mendez Roman I; López-Vélez R
[Ad] Endereço:Department of Preventive Medicine and Public Health & Immunology and Microbiology, Rey Juan Carlos University, Avda. Atenas s/n, Alcorcón, Madrid, Spain, 28922.
[Ti] Título:Interventions for Old World cutaneous leishmaniasis.
[So] Source:Cochrane Database Syst Rev;12:CD005067, 2017 12 01.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cutaneous leishmaniasis, caused by a parasitic infection, is considered one of the most serious skin diseases in many low- and middle-income countries. Old World cutaneous leishmaniasis (OWCL) is caused by species found in Africa, Asia, the Middle East, the Mediterranean, and India. The most commonly prescribed treatments are antimonials, but other drugs have been used with varying success. As OWCL tends to heal spontaneously, it is necessary to justify the use of systemic and topical treatments. This is an update of a Cochrane Review first published in 2008. OBJECTIVES: To assess the effects of therapeutic interventions for the localised form of Old World cutaneous leishmaniasis. SEARCH METHODS: We updated our searches of the following databases to November 2016: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). We wrote to national programme managers, general co-ordinators, directors, clinicians, WHO-EMRO regional officers of endemic countries, pharmaceutical companies, tropical medicine centres, and authors of relevant papers for further information about relevant unpublished and ongoing trials. We undertook a separate search for adverse effects of interventions for Old World cutaneous leishmaniasis in September 2015 using MEDLINE. SELECTION CRITERIA: Randomised controlled trials of either single or combination treatments in immunocompetent people with OWCL confirmed by smear, histology, culture, or polymerase chain reaction. The comparators were either no treatment, placebo/vehicle, and/or another active compound. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias and extracted data. We only synthesised data when we were able to identify at least two studies investigating similar treatments and reporting data amenable to pooling. We also recorded data about adverse effects from the corresponding search. MAIN RESULTS: We included 89 studies (of which 40 were new to this update) in 10,583 people with OWCL. The studies included were conducted mainly in the Far or Middle East at regional hospitals, local healthcare clinics, and skin disease research centres. Women accounted for 41.5% of the participants (range: 23% to 80%). The overall mean age of participants was 25 years (range 12 to 56). Most studies lasted between two to six months, with the longest lasting two years; average duration was four months. Most studies were at unclear or high risk for most bias domains. A lack of blinding and reporting bias were present in almost 40% of studies. Two trials were at low risk of bias for all domains. Trials reported the causative species poorly.Here we provide results for the two main comparisons identified: itraconazole (200 mg for six to eight weeks) versus placebo; and paromomycin ointment (15% plus 10% urea, twice daily for 14 days) versus vehicle.In the comparison of oral itraconazole versus placebo, at 2.5 months' follow up, 85/125 participants in the itraconazole group achieved complete cure compared to 54/119 in the placebo group (RR 3.70, 95% CI 0.35 to 38.99; 3 studies; 244 participants). In one study, microbiological or histopathological cure of skin lesions only occurred in the itraconazole group after a mean follow-up of 2.5 months (RR 17.00, 95% CI 0.47 to 612.21; 20 participants). However, although the analyses favour oral itraconazole for these outcomes, we cannot be confident in the results due to the very low certainty evidence. More side effects of mild abdominal pain and nausea (RR 2.36, 95% CI 0.74 to 7.47; 3 studies; 204 participants) and mild abnormal liver function (RR 3.08, 95% CI 0.53 to 17.98; 3 studies; 84 participants) occurred in the itraconazole group (as well as reports of headaches and dizziness), compared with the placebo group, but again we rated the certainty of evidence as very low so are unsure of the results.When comparing paromomycin with vehicle, there was no difference in the number of participants who achieved complete cure (RR of 1.00, 95% CI 0.86, 1.17; 383 participants, 2 studies) and microbiological or histopathological cure of skin lesions after a mean follow-up of 2.5 months (RR 1.03, CI 0.88 to 1.20; 383 participants, 2 studies), but the paromomycin group had more skin/local reactions (such as inflammation, vesiculation, pain, redness, or itch) (RR 1.42, 95% CI 0.67 to 3.01; 4 studies; 713 participants). For all of these outcomes, the certainty of evidence was very low, meaning we are unsure about these results.Trial authors did not report the percentage of lesions cured after the end of treatment or speed of healing for either of these key comparisons. AUTHORS' CONCLUSIONS: There was very low-certainty evidence to support the effectiveness of itraconazole and paromomycin ointment for OWCL in terms of cure (i.e. microbiological or histopathological cure and percentage of participants completely cured). Both of these interventions incited more adverse effects, which were mild in nature, than their comparisons, but we could draw no conclusions regarding safety due to the very low certainty of the evidence for this outcome.We downgraded the key outcomes in these two comparisons due to high risk of bias, inconsistency between the results, and imprecision. There is a need for large, well-designed international studies that evaluate long-term effects of current therapies and enable a reliable conclusion about treatments. Future trials should specify the species of leishmaniasis; trials on types caused by Leishmania infantum, L aethiopica, andL donovani are lacking. Research into the effects of treating women of childbearing age, children, people with comorbid conditions, and those who are immunocompromised would also be helpful.It was difficult to evaluate the overall efficacy of any of the numerous treatments due to the variable treatment regimens examined and because RCTs evaluated different Leishmania species and took place in different geographical areas. Some outcomes we looked for but did not find were degree of functional and aesthetic impairment, change in ability to detect Leishmania, quality of life, and emergence of resistance. There were only limited data on prevention of scarring.
[Mh] Termos MeSH primário: Antiprotozoários/uso terapêutico
Itraconazol/uso terapêutico
Leishmaniose Cutânea/terapia
Paromomicina/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Animais
Anti-Infecciosos/uso terapêutico
Antiprotozoários/administração & dosagem
Terapias Complementares/métodos
Crioterapia/métodos
Extremo Oriente
Feminino
Temperatura Alta/uso terapêutico
Seres Humanos
Itraconazol/administração & dosagem
Terapia a Laser
Leishmania major
Leishmania tropica
Masculino
Meia-Idade
Oriente Médio
Bases para Pomadas/administração & dosagem
Paromomicina/administração & dosagem
Fotoquimioterapia
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anti-Infective Agents); 0 (Antiprotozoal Agents); 0 (Ointment Bases); 304NUG5GF4 (Itraconazole); 61JJC8N5ZK (Paromomycin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD005067.pub5



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